da Trindade Rafael Queiroz, Duarte Morais Vieira Maria Gabriela, Vieira Raíssa Bastos, Vicentin-Junior Carlos Antonio, Damascena Nicole Prata, Santiago Bianca Marques, Martins-Filho Paulo Ricardo, Palhares Machado Carlos Eduardo
Graduate Program in Oral Biology, Piracicaba Dental School, State University of Campinas, UNICAMP, São Paulo, Brazil.
Graduate Program in Pathology, Ribeirão Preto Medical School, University of São Paulo, USP, São Paulo, Brazil.
J Forensic Leg Med. 2023 Oct;99:102591. doi: 10.1016/j.jflm.2023.102591. Epub 2023 Sep 12.
Drowning is a significant global cause of unintentional injury fatalities, and accurate forensic diagnosis of drowning remains a challenge due to the nonspecific nature of post-mortem findings obtained through classical autopsy methods. Our manuscript addresses this issue by focusing on the emerging use of paranasal sinus fluid as a valuable tool in determining the cause of death, specifically in distinguishing drowning from non-drowning cases. The study provided a comprehensive summary of available evidence from observational studies that compared findings in the paranasal sinuses between drowning and non-drowning victims, analyzing parameters such as the presence of fluid, fluid volume, and density. The study encompassed a total of 14 selected studies involving 1044 subjects and utilized rigorous risk of bias assessment and data synthesis techniques. The meta-analysis demonstrated a strong association between the presence of fluid in the paranasal sinuses and drowning (OR = 17.1; 95% CI 7.2 to 40.5; p < 0.001). In addition, drowning victims had a significantly greater volume of fluid (SMD = 0.8; 95% CI 0.5 to 1.2; p < 0.001) and lower fluid density (SMD = -1.4; 95% -2.5 to -0.4; p = 0.008) compared to non-drowning cases. The results support the utility of paranasal sinus fluid analysis as a valuable diagnostic method in cases where drowning is suspected but cannot be definitively confirmed through traditional approaches.
溺水是全球意外受伤死亡的一个重要原因，由于通过传统尸检方法获得的死后发现具有非特异性，溺水的准确法医诊断仍然是一项挑战。我们的手稿通过关注鼻窦液作为确定死因的宝贵工具的新用途来解决这个问题，特别是在区分溺水和非溺水病例方面。该研究全面总结了观察性研究的现有证据，这些研究比较了溺水和非溺水受害者鼻窦的发现，分析了诸如液体存在、液体量和密度等参数。该研究总共纳入了14项选定的研究，涉及1044名受试者，并采用了严格的偏倚风险评估和数据合成技术。荟萃分析表明鼻窦中存在液体与溺水之间存在强烈关联（OR = 17.1；95% CI 7.2至40.5；p < 0.001）。此外，与非溺水病例相比，溺水受害者的液体量显著更大（SMD = 0.8；95% CI 0.5至1.2；p < 0.001），液体密度更低（SMD = -1.4；95% -2.5至-0.4；p = 0.008）。这些结果支持鼻窦液分析作为一种有价值的诊断方法在怀疑溺水但无法通过传统方法明确确认的病例中的实用性。
